In one clinical intervention based on this approach, the client is taught to visualize the urge or craving as a wave, watching it rise and fall as an observer and not to be “wiped out” by it. This imagery technique is known as “urge surfing” and refers to conceptualizing the urge or craving as a wave that crests and then washes onto a beach. In so doing, the client learns that rather than building interminably until they become overwhelming, urges and cravings peak and subside rather quickly if they are not acted on. The client is taught not to struggle against the wave or give in to it, thereby being “swept away” or “drowned” by the sensation, but to imagine “riding the wave” on a surf board.
Relative to a control condition, ABM resulted in significantly improved ability to disengage from alcohol-related stimuli during attentional bias tasks. While incidence of relapse did not differ between groups, the ABM group showed a significantly longer time to first heavy drinking day compared to the control group. Additionally, the intervention had no effect on subjective measures of craving, suggesting the possibility that intervention effects may have been specific to implicit cognitive processes 62. Overall, research on implicit cognitions stands to enhance understanding of dynamic relapse processes and could ultimately aid in predicting lapses during high-risk situations. In the first study to examine relapse in relation to phasic changes in SE 46, researchers reported results that appear consistent with the dynamic model of relapse.
Treatment
Below is a description of several of these tools, including information about how to access them and limitations. The consensus panel recommends asking clients to look at the skills they used to obtain substances and reframing those as strengths. Limited research has looked at the effects of intersecting identities on SUD treatment.513 More is known about the associations between intersecting identities and substance use, information that is useful for counselors. Maintain communication with recovery resource partners (e.g., if a counselor links a client to peer support services, the counselor should be available to the peer provider for consultation and feedback on how the client is doing). Provide services based on the client’s most urgent needs (e.g., housing, food, child care). Depending on the setting, counselors providing or thinking of providing recovery-oriented counseling may need to consider the ways that payment systems can affect delivery of care.
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It is inevitable that the next decade will see exponential growth in this area, including greater use of genome-wide analyses of treatment response 109 and efforts to evaluate the clinical utility and cost effectiveness of tailoring treatments based on pharmacogenetics. Finally, an intriguing direction is to evaluate whether providing clients with personalized genetic information can facilitate reductions in substance use or improve treatment adherence 110,111. Many smoking cessation studies have sought to identify factors that influence cessation success versus failure. Rather than focusing on binary and distal relapse outcomes, our analyses aimed to advance understanding of factors that influence the dynamic process of recurrent lapse episodes recorded as participants attempted to maintain abstinence from smoking. The analysis evaluated the way emotional and cognitive responses to smoking lapses prospectively affect subsequent lapse progression. We assessed the implications of Marlatt’s AVE concept, which holds that each lapse – not just the first – represents a pivotal situation after which the lapser will either become increasingly demoralized or remain confident and committed to cessation.
Specific Intervention Strategies
A key feature of the dynamic model is its emphasis on the complex interplay between tonic and http://ivs.d0f.myftpupload.com/2024/11/the-7-stages-of-alcoholism-a-detailed-caron-2/ phasic processes. As indicated in Figure 2, distal risks may influence relapse either directly or indirectly (via phasic processes). For instance, the return to substance use can have reciprocal effects on the same cognitive or affective factors (motivation, mood, self-efficacy) that contributed to the lapse. Lapses may also evoke physiological (e.g., alleviation of withdrawal) and/or cognitive (e.g., the AVE) responses that in turn determine whether use escalates or desists.
When experiencing AVE, individuals tend to internalize their lapse as a personal weakness which diminishes their self esteem. The negative internalization escalates into beliefs such as being unable to control their behaviors and that their efforts were for nothing. At this point, the individual is likely in a vulnerable state, triggering the desire to use or engage in the behavior again. The combination of these negative emotions and beliefs can further exacerbate the degree of the lapse and derail amphetamine addiction treatment from their recovery process. Without addressing the impact that AVE has, it can inhibit the ability to achieve recovery goals.
The term “abstinence violation effect” refers to the emotional response experienced by individuals who have relapsed after committing to abstain from a certain behavior, such as substance abuse or unhealthy eating habits. This effect often involves feelings of guilt, shame, and self-blame, which can further perpetuate the cycle of relapse. Understanding and addressing the abstinence violation effect is crucial in helping individuals break free from harmful behaviors and maintain long-term recovery.
Survival analysis assesses risk for an event by analyzing the incidence of the event over a specified period of time, referred the abstinence violation effect refers to to as the event’s hazard. Single-event survival analysis examines a single event, assuming that no further events are possible (it was originally developed to analyze death rates). In contrast, recurrent events survival analyses assess the hazard of events that can occur multiple times (e.g., lapses). Recurrent models incorporating both the timing and sequence of lapses made it possible to systematically examine the extent to which each successive AVE response prospectively accelerated lapses across the series, driving the process downward toward relapse.
This suggests that smokers should be encouraged to remain on treatment even after they have lapsed, at least through the first 8–10 lapses, while persisting in efforts to recover abstinence as soon as possible. Conversely, it also suggests when it may no longer be productive to persist in patch treatment in the face of an extended series of recurring lapses. We also observed that the effects of active patch assignment on progression were moderated by lapse-related guilt, such that elevated guilt accelerated progression among those on active patch, while it was protective among those on placebo. It is not clear why such psychological reactions should interact with pharmacological treatment. Further exploration of the interaction between guilt and NRT treatment – and, more broadly, between pharmacological and psychological factors in relapse – is warranted.
Mechanisms of treatment effects
- In one clinical intervention based on this approach, the client is taught to visualize the urge or craving as a wave, watching it rise and fall as an observer and not to be “wiped out” by it.
- Setbacks are a normal part of the recovery, meaning the isolated event is not an indicator of overall failure.
- Based on the classification of relapse determinants and high-risk situations proposed in the RP model, numerous treatment components have been developed that are aimed at helping the recovering alcoholic cope with high-risk situations.
Participants self-monitored weight, food intake, and physical activity daily and submitted self-monitoring records weekly. Interventionists provided written feedback related to weight, nutrition, and exercise on self-monitoring diaries weekly in the first month and monthly thereafter. In a 2013 Cochrane review which also discussed regarding relapse prevention in smokers the authors concluded that there is insufficient evidence to support the use of any specific behavioural intervention to help smokers who have successfully quit for a short time to avoid relapse. The verdict is strongest for interventions focused on identifying and resolving tempting situations, as most studies were concerned with these24. Relapse poses a fundamental barrier to the treatment of addictive behaviors by representing the modal outcome of behavior change efforts 1-3.